Provider Demographics
NPI:1952047383
Name:FA'AKASI FAMILY COUNSELING LLC
Entity Type:Organization
Organization Name:FA'AKASI FAMILY COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:KELSI
Authorized Official - Middle Name:
Authorized Official - Last Name:MEREDITH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:480-209-9698
Mailing Address - Street 1:1553 AVENIDA DE QUINTAS
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-3506
Mailing Address - Country:US
Mailing Address - Phone:480-209-9698
Mailing Address - Fax:
Practice Address - Street 1:1553 AVENIDA DE QUINTAS
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-3506
Practice Address - Country:US
Practice Address - Phone:480-209-9698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1235510397Medicaid